<?php require_once 'head.php'; ?>
<?php require_once 'header.php'; ?>


<div class="or-spacer">
        <div class="mask"></div>
        <span><i>AA</i></span>
</div>
<div id="" class="content_wrapper">
    <form action="process_form.php" method="post" id="form_page_content" class="inner_content stitcher">
        <label for="form_name">Numele Dumneavoastra</label> 
        <input id="form_name" type="text" name="name">
        
        <label for="form_email-address">Emailul Dumneavoastra</label> 
        <input id="form_email-address" type="text" name="email-address">
        
        <label for="form_phone">Numarul de Telefon</label> 
        <input id="form_phone" type="text" name="phone">
        
        <label for="form_vrd">Numarul Autoturismului</label> 
        <input id="form_name" type="text" name="vrd">
        <label for="form_vrd_file">Poza talonului mare.</label> 
        <input id="form_vrd_file" type="file" name="vrd_file" value="alegeti file">
        
        <label for="form_name_recipient">Numele omului care primeste documentele</label> 
        <input id="form_name_recipient" type="text" name="name_recipient">
        
        <label for="form_phone_recepient">Telefonul Primitorului</label> 
        <input id="form_phone_recepient" type="text" name="phone_recipient">
        
        <label for="form_address">Adresa Primitoroului</label> 
        <input id="form_address" type="text" name="address">
        
        <hr>
        <input id="send_form_but" type="submit" name="submit" value="Trimite">
        
        
    </form>
</div>

<?php require_once 'foot.php'; ?>
